Assessment of the Anthelmintic Efficacy of Albendazole in School Children in Seven Countries Where Soil-Transmitted Helminths Are Endemic

Soil-transmitted helminths (roundworms, whipworms and hookworms) infect millions of children in (sub)tropical countries, resulting in malnutrition, growth stunting, intellectual retardation and cognitive deficits. Currently, there is a need to closely monitor anthelmintic drug efficacy and to develop standard operating procedures, as highlighted in a World Health Organization–World Bank meeting on “Monitoring of Drug Efficacy in Large Scale Treatment Programs for Human Helminthiasis” in Washington DC at the end of 2007. Therefore, we have evaluated the efficacy of a commonly used treatment against these parasitic infections in school children in Africa, Asia and South-America using a standardized protocol. In addition, different statistical approaches to analyzing the data were evaluated in order to develop standardized procedures for data analysis. The results demonstrate that the applied treatment was highly efficacious against round- and hookworms, but not against whipworms. However, there was large variation in efficacy across the different trials which warrants further attention. This study also provides new insights into the statistical analysis of efficacy data, which should be considered in future monitoring and evaluation studies of large scale anthelmintic treatment programs. Finally, our findings emphasize the need to update the World Health Organization recommended efficacy threshold for the treatment of STH

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Assessing the burden of human cysticercosis in Vietnam

Objectives: To describe the occurrence of cysticercosis in patients living in rural areas of Northern Vietnam presenting clinical signs of neurocysticercosis. Methods: Serological antigen detection, reflecting current infection with viable larval stages of Taenia solium, was used to estimate the prevalence of active cysticercosis in this patient population. Results: The seroprevalence in epileptic patient population was <10%. However, antigen detection cannot detect dead cysticerci, which may also cause clinical signs. Therefore, the seroprevalence figures shown here may underestimate the role of neurocysticercosis as a causal agent of epilepsy and headaches in this population. Conclusions: Human and porcine cysticercosis remain public and veterinary public health problems in Northern Vietnam and probably in other parts of the country

High latrine coverage is not reducing the prevalence of soil-transmitted helminthiasis in Hoa Binh province, Vietnam

A baseline epidemiological survey for parasite infections was conducted between December 2007 and January 2008 in 155 villagers in a rural commune in Hoa Binh province, Vietnam, The prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm infection was 13.5%, 45.2% and 58.1%, respectively. At least one of the parasites was detected in 72.3% of the samples. We found no association between infection with A. lumbricoides or T trichiura and engagement in agriculture, white hookworm infection was more prevalent in populations having frequent contact with soil. Agricultural use of human faeces was not correlated with any of the infections. We suggest that the consumption of vegetables that are commonly fertilized with human faeces in the community has led to the high infection rates with A. lumbricoides and T trichiura, rather than the manipulation of faeces in farming activity. This also explains the high infection prevalence, despite high latrine coverage (98.1%) in ! the study population. The presence of latrines atone is not sufficient to reduce the prevalence of helminthiasis in a rural agricultural community if fresh faeces are used as fertilizer

Sero-Prevalence of SARS-CoV-2 in High-Risk Populations in Vietnam

Background: As a response to the coronavirus disease 2019 (COVID-19) pandemic, Vietnam enforced strict quarantine, contact tracing and physical distancing policies. By December 2020, this strategy resulted in one of the lowest numbers of individuals infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) cases globally. This study aimed to determine the prevalence of SARS-CoV-2 antibody positivity among high-risk populations in Vietnam.Methods: A prevalence survey was undertaken within four communities in northern and central Vietnam, where at least two COVID-19 cases had been confirmed. Participants were classified according to the location of exposure: household contacts, close contacts, community members, and healthcare workers (HCWs) responsible for treating COVID-19 cases. Participants completed a baseline questionnaire that evaluated exposure history. SARS-CoV-2 IgG antibodies were quantified using a commercially available assay.Results: 3056 community members and 149 health care workers provided consent to participate. Among enrolled community members, 27 (0·9%) were household contacts and 53 (1·7%) were close contacts. Serology was performed in 3034 individuals. Among 13 individuals who were seropositive (0·4%), five household contacts (5/27, 18·5%), one close contact (1/53, 1·9%), and seven community members (7/2954, 0·2%) had detectable SARS-CoV-2 antibodies. All HCWs were negative for SARS-CoV-2 antibodies. Participants were tested a median of 15·1 (interquartile range 14·9 to 15·2) weeks after exposure.Conclusion: The presence of SARS-CoV-2 antibodies in high-risk communities and healthcare workers was low in communities in Vietnam with known COVID-19 cases. The public health response to the COVID-19 pandemic in Vietnam has been effective in limiting community transmission of SARS-CoV-2.Funding Statement: This project was supported by a grant funded by the Australian Department of Foreign Affairs and Trade, awarded in conjunction with the Australian National Health and Medical Research Council (APP1153346).Declaration of Interests: None declared.Ethics Approval Statement: Ethical approval was obtained from the Human Research Ethics Committees of the University of Sydney (HREC 2020/415) and Biomedical Research Ethics Committee of the National Hospital for Tropical Diseases (No. 10/HDDD-NDTU and No. 18/HDDD-NDTU). Consent was documented electronically using a tablet computer. In accordance with local expectations, all COVID-19 patients and other participants were provided with monetary compensation for their participation, equivalent to approximately US$4·30 and US$2·20, respectively

Identifying thresholds to classify moderate-to-heavy soil-transmitted helminth intensity infections for FECPAK(G2), McMaster, Mini-FLOTAC and qPCR

Author summary The prevalence of moderate-to-heavy intensity (M&HI) infections is a key indicator for measuring the success of large-scale deworming programs for intestinal worms because they account for the majority of the worm attributable morbidity. Currently, intestinal worm infections are classified as M&HI when the number of worm eggs that are microscopically detected in stool using a standard diagnostic method exceeds a threshold set by the World Health Organization. Over the years, a variety of new promising diagnostic methods have been introduced for the diagnosis of intestinal worms. Although they have some important advantages over the current standard method, it is not clear whether they can reliably classify M&HI infections. This is because their test results either systematically indicate lower egg counts or are expressed in a unit other than eggs per gram of stool (e.g, concentration of worm DNA), warranting the need for method-specific thresholds. We defined method-specific thresholds and verified whether they increased the correct classification of M&HI infections. Overall, our results indicate that method-specific thresholds improved the classification of M&HI infections, but that further validation is required before they can be recommended for evaluating the occurrence M&HI infections in large-scale deworming programs.World Health Organization (WHO) has defined moderate-to-heavy intensity (M&HI) infections with soil-transmitted helminths (Ascaris lumbricoides,Trichuris trichiuraand the two hookworms,Ancylostoma duodenaleandNecator americanus) based on specific values of eggs per gram of stool, as measured by the Kato-Katz method. There are a variety of novel microscopy and DNA-based methods but it remains unclear whether applying current WHO thresholds on to these methods allows for a reliable classification of M&HI infections. We evaluated both WHO and method-specific thresholds for classifying the M&HI infections for novel microscopic (FECPAK(G2), McMaster and Mini-FLOTAC) and DNA-based (qPCR) diagnostic methods. For this, we determined method-specific thresholds that best classified M&HI infections (defined by Kato-Katz and WHO thresholds; reference method) in two multi-country drug efficacy studies. Subsequently, we verified whether applying these method-specific thresholds improved the agreement in classifying M&HI infections compared to the reference method. When we applied the WHO thresholds, the new microscopic methods mainly misclassified M&HI as low intensity, and to a lesser extent low intensity infection as M&HI. For FECPAK(G2), applying the method-specific thresholds significantly improved the agreement forAscaris(moderate -> substantial),Trichurisand hookworms (fair -> moderate). For Mini-FLOTAC, a significantly improved agreement was observed for hookworms only (fair -> moderate). For the other STHs, the agreement was almost perfect and remained unchanged. For McMaster, the method-specific thresholds revealed a fair to a substantial agreement but did not significantly improve the agreement. For qPCR, the method-specific thresholds based on genome equivalents per ml of DNA moderately agreed with the reference method for hookworms andTrichurisinfections. ForAscaris, there was a substantial agreement. We defined method-specific thresholds that improved the classification of M&HI infections. Validation studies are required before they can be recommended for general use in assessing M&HI infections in programmatic settings